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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2024, Vol. 10 ›› Issue (02) : 100 -107. doi: 10.3877/cma.j.issn.2095-9605.2024.02.005

青年专家论坛

肥胖与内镜下减重治疗研究进展
周彪1, 李政奇1, 孟化1,†()   
  1. 1. 100029　北京，中日友好医院普外科代谢减重中心
  • 收稿日期:2024-03-07 出版日期:2024-05-30
  • 通信作者: 孟化
  • 基金资助:
    中日友好医院中央高水平医院临床科研业务费资助(2023-NHLHCRF-YS-0103；2023-NHLHCRF-YYPP-TS-02); 北京市研究型病房建设临床研究项目(2022-YJXBF-03-02)

Advances in obesity and endoscopic bariatric treatment

Biao Zhou1, Zhengqi Li1, Hua Meng1,†()   

  1. 1. General surgery department and metabolic and bariatric center, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2024-03-07 Published:2024-05-30
  • Corresponding author: Hua Meng
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周彪, 李政奇, 孟化. 肥胖与内镜下减重治疗研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(02): 100-107.

Biao Zhou, Zhengqi Li, Hua Meng. Advances in obesity and endoscopic bariatric treatment[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2024, 10(02): 100-107.

肥胖症已成为我国重大公共卫生问题，中重度肥胖患者进行饮食运动干预效果有限且难以长期坚持，而减重手术由于手术风险和较高成本临床应用受到一定限制。内镜下减重治疗具有更微创、恢复快、可逆、可重复、并发症少等优势，在设备、技术、理念等方面不断发展，有望成为减重代谢手术的并行和补充治疗。内镜下减重治疗依据原理可分为限制胃容量、减少肠道吸收、内镜下修正手术三大类。内镜减重可联合药物、减重手术进行综合治疗，将成为肥胖症多学科综合治疗中重要的一个环节。

关键词: 肥胖, 内镜, 多学科, 综合治疗, 减重代谢手术

Obesity has become a major public health problem in China. Diet and exercise interventions in patients with moderate to severe obesity have limited effect and is difficult to adhere to for a long time. The clinical application of bariatric surgery is limited due to the surgical risk and high cost. Endoscopic bariatric therapy (EBT) has the advantages of being more minimally invasive, faster recovery, reversible, repeatable, and less complications. It is constantly developing in terms of equipment, technology, and concept, and is expected to become a parallel and complementary treatment for bariatric and metabolic surgery. According to the principle, EBT can be divided into three categories: restriction of stomach volume, reduction of intestinal absorption, and endoscopic revisional surgery. EBT can be combined with drugs and bariatric surgery for comprehensive treatment, which will become an important link in the multidisciplinary comprehensive treatment of obesity.

Key words: Obesity, Endoscopic bariatric therapy, Multidisciplinary, Comprehensive treatment, Metabolic and bariatric surgery
表1 内镜下减重治疗原理和特点
内镜下减重治疗类型 原理 操作
胃内球囊置入术（IGB） 限制胃容量、延迟排空 通过胃镜置入或直接吞咽将球囊置入胃内，球囊充盈后占据胃内容积，包括单球囊或多球囊
内镜下袖状胃成型术（ESG） 限制胃容量、延迟排空 利用Overstich内镜下全层缝合系统从胃腔内对胃壁进行一系列间断或连续缝合形成胃大弯侧折叠以减少胃容量
腔内减重手术（POSE） 限制胃容量、延迟排空 在胃腔内进行大弯侧全层间断缝合完成胃大弯折叠，同时沿大弯侧皱襞纵向间断缝合缩小胃长径，以减少胃容量，原理与ESG类似
内镜下十二指肠-空肠旁路套管置入术（EDJBL） 减少肠道吸收、调整肠道激素释放 将长约60 cm的套管膜置入十二指肠和近段空肠，隔绝食物和相应部位肠粘膜接触，影响与胰岛素抵抗相关激素释放
十二指肠黏膜重建术（DMR） 减少肠道吸收、调整肠道激素释放 将一球囊导管置入十二指肠降段，将热水注入球囊以消融十二指肠黏膜，达到限制吸收，调整胃肠激素分泌
内镜下经口输出道缩小术（TORe） 缩小RYGB手术的胃肠吻合口 利用OverStitch设备对RYGB手术的胃肠吻合口处进行全层缝合以缩小吻合口
表2 胃内球囊产品对比
产品名称 置入方式 球囊数量（个） 容量 置入时间（月） 取出方式 减重效果
Orbera球囊/Orbera 365球囊 胃镜下置入 1 450~700 mL 6~12 经胃镜取出 11.8%~18.42%（%TWL）
Obalon可吞咽球囊 吞咽 1~3 单个球囊250 mL 6 经胃镜取出 约40%（%EWL）
Spatz3可调节球囊 胃镜下置入 1 600 mL 12 经胃镜取出 15%（%TWL）
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